Fieldset
Innovation: How ultrasound is saving lives in South Sudan

Stephen is a midwife from South Sudan, working with MSF in Malakal camp to provide care to people displaced by conflict. In this post, he explains how new kit and training in "point-of-care" ultrasound scans are helping midwives like him make life-saving diagnoses.

My name is Obulejo Stephen Melebi, a 27-year-old midwife with Médecins sans Frontières / Doctors Without Borders (MSF).

It may sound surprising for some to hear about a male midwife, but my sister (who also joined the profession) inspired me to follow after her.

In South Sudan, there is a severe lack of medical staff and anyone with medical experience is highly appreciated, including a midwife like me. In only rare occasions has anyone shown any consternation towards my services as a male midwife.

Before we had ultrasound in Malakal, complicated pregnancies could lead to tragedy.

And, it’s a profession that motivates me, working to see babies safely delivered across the country. I have worked as a midwife for the government in the towns of Kajo Keji and Torit in the Greater Equatoria region, and, for the past three years, with MSF in other areas such as Gogrial and now Malakal.

The impact of ultrasound

My career in midwifery started in Kajo Keji at the National Health Training Institute. It is here that I was trained not only to deliver babies, but to treat difficult deliveries.

I help with complications and often make the decision to refer women with difficult pregnancies to specialist services when necessary. These skills in dealing with complicated cases were greatly enhanced once I was trained and started using an ultrasound machine here in Malakal.

 

In the past, before we were equipped to use ultrasound, patients with suspected pregnancy complications were taken long distances to receive a scan.

When working in Gogrial, for instance, pregnant women had to travel vast distances in often challenging conditions to receive the scan either in Aweil or Agok, which can be a six hour drive away.

It’s a long journey and even longer during the rainy season with muddied roads.

Outside of MSF facilities, even places with ultrasound machines are often still inaccessible to many people since it would cost the patient money for the scan to take place.

Looking back

When I started using the ultrasound scan with MSF, I reflected back to a time without the device when obstetric emergencies could have been prevented — even maternal and foetal deaths.

Before we had ultrasound in Malakal, complicated pregnancies could lead to tragedy.

If a new mother has a baby boy, some have even named their child 'Steve' to acknowledge my work.

One time, I was sent to meet an expectant mother who had twins. However, we did not realise this since her placenta came out after the first child was born – something normal for a regular delivery – meaning we thought her labour was over.

The new mother’s womb was still larger than usual and we did not expect twins since some women have a condition known as polyhydramnios, whereby excess fluid makes the womb appear larger than necessary.

Unfortunately, the second child passed away. It is an experience I shall always deeply regret.  

If we had an ultrasound machine and training to use it at that time, this could have been prevented.

Game changer

Now that I routinely use an ultrasound machine in Malakal, it has proven to be a real game-changer.

For me, the introduction of basic scanning in the maternity ward has greatly improved decision-making.

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A patient receives an ultrasound scan in Malakal
A patient receives an ultrasound scan in Malakal
 

After getting a patient’s information, history and physical examination, if you feel you need to know more, you can investigate further and conclude an accurate diagnosis without seeking a doctor.

Perhaps, in simple terms, we can compare the introduction of ultrasound scanning here to the rapid diagnostic tests we now use for malaria.

Previously, blood samples and an analysis under a microscope were required to determine whether a patient had malaria. That’s a process that could take hours. Now, we have rapid malaria tests that can take ten minutes.

Africa’s newest country

Our work is more crucial than ever at this time in South Sudan.

“Africa’s newest country” has one of the highest child mortality rates, with 96 deaths per 1,000 births, according to 2017 UN statistics. That’s nearly ten percent of all children below five years of age.

Further to this, conflict has disrupted hospitals and even the crucial medical training that I managed to receive – just in time before fighting broke out.

Despite the challenges and uncertainty ahead, one thing I can say with certainty is that the job of a midwife is very rewarding. There is nothing better than seeing a mother leaving the hospital here in Malakal, walking home with her newborn child.

If a new mother has a baby boy, some have even named their child “Steve” to acknowledge my work. If a girl is born, they sometimes name her after my lovely mother, who is called “Queen”.

So, if you happen to be walking through the streets of Malakal and meet a young boy or girl named Steve or Queen, maybe you’ll remember this story.